Rural Emergency Room Simulation Teaching and Education Resource

Rural Emergency Room Simulation Teaching and Education Resource

Dealing with an acutely decompensating patient suspected of having a pulmonary embolus can be a challenge. The issue for rural physicians, especially without CT scanners, nor readily available BNP measurements etc can make it that much more daunting.What has changed over the years is not defining PE by 'clot burden' but rather whether the patient is having hemodynamic compromise from right ventricular failure secondary to a PE. Right ventricular failure can be 'assessed' in the ER with ultrasound. No, this is not as precise as an Echocardiogram, but it can at least give the GP an idea if there is RV dilation and/or septal bulging that would be consistent with a PE.

The treatment for uncomplicated, stable PE is based on protocol with LMWH and Warfarin. The literature now seems to advocate thrombolytic therapy for the 'crashing' massive PE or the patient in PEA/cardiac arrest thought to be due to PE.

Where the controversy seems to remain is the 'submassive' PE, where there is RV dysfunction and some cardiac/hemodynamic compromise. Then the issue is the whether the benefits of thrombolytics outweigh the potential risks.

This debate is NOT over, nor are protocols for these 'submassive" PE's consistent among the experts throughout the world. Stay tuned! hopefully things will become clearer with time and more research.

The power point below hopes to clarify 'what is known today' and what the options are realistically for the rural doctor facing these patients.